Case series of protective ventilation for ARDS using partial extracorporeal CO2 removal

Rauch S.1, Roth H.2, Deininger T.2, Kuhwald A.2, Lund L.3, Fischer M.1

1ALB FILS KLINIKEN, Anesthesiology, Göppingen, Germany, 2ALB FILS KLINIKEN, Internal Medicine, Göppingen, Germany, 3ALung Technologies Inc., Pittsburgh, United States

Poster presentation from the EuroELSO 2015 4th International Congress

Objectives

In the ARDS Network trial of low tidal volume ventilation, hypercapnia and respiratory acidosis were controlled in the lower tidal volume patients using ventilation rate and bicarbonate infusion so as not to differ statistically from the control arm. Since the ARDS Network study, there has been significant progress in extracorporeal CO2 removal (ECCO2R) technology, now inspiring its use as a tool to facilitate more protective ventilation strategies. Our objective was to evaluate the safety and feasibility of incorporating the use of partial, ultra-low flow ECCO2R in our treatment paradigm to facilitate protective ventilation while controlling hypercapnia and respiratory acidosis.

Methods

We analyzed retrospectively a case series in 5 patients with mild or moderate ARDS using an ultra-low flow ECCO2R device (Hemolung RAS, ALung Technologies) to enable either lower plateau pressures via reduced tidal volumes, or lower respiratory rates, which have also been shown to reduce VILI. The Hemolung RAS uses a 15.5 French dual lumen catheter inserted in either the femoral or jugular vein, and provides removal of up to 50% of basal CO2 production at flows of 400-500 mL/min.

Results

Four patients with moderate ARDS and one with mild ARDS were treated with this strategy. There were no adverse events associated with the device in any patients. All 4 moderate ARDS patients (3 due to community acquired pneumonia and one to ventilator associated pneumonia) recovered successfully and were discharged. We were able to achieve lung protective ventilation in the 2nd patient, but he then developed pneumonia, leading to refractory hypoxemia and transition to ECMO, and ultimately did not survive. There were no adverse events associated with the device in any patients. All 4 moderate ARDS patients (3 due to community acquired pneumonia and one to ventilator associated pneumonia) recovered successfully and were discharged. We were able to achieve lung protective ventilation in the 2nd patient, but he then developed pneumonia, leading to refractory hypoxemia and transition to ECMO, and ultimately did not survive.

Conclusion

The use of partial ECCO2R to facilitate lung protective ventilation was easily implemented, and found to be safe and effective in our patients.

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Case series of protective ventilation for ARDS using partial extracorporeal CO2 removal thumbnail

Case series of protective ventilation for ARDS using partial extracorporeal CO2 removal